Patriot Exchange Program - Standard

Plan Detail

Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

Benefits


 

Benefits Limit
Plan Maximum Choice of $50,000, $250,000 or $500,000 per illness or injury with a Lifetime Maximum of $5,000,000.
Coinsurance No coinsurance
Deductible $100 per Illness or Injury
Treatment Period 60 days per chronic illness
MyIMGSM 24 hour secure access from anywhere in the world to manage
your account at anytime
International Emergency Care A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains
Dependent Coverage Coverage provided for dependents of faculty, scholars, students and exchange participants
Optional Add-on Plan Additional coverage is available for high school sports, personal liability and legal assistance
MEDICAL BENEFITS Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
Hospital Room and Board Up to semi-private room rate
Hospital Intensive Care Usual, Reasonable and Customary charges
Physical Therapy Usual, Reasonable and Customary charges- 1 visit per day
Physician Visit Usual, Reasonable and Customary charges
Student Health Center $5 co-pay per visit
Prescription Drugs Usual, Reasonable and Customary charges
Eligible Medical Expenses Usual, Reasonable and Customary charges
Emergency Room Usual, Reasonable and Customary charges
Emergency Room Illness with In-patient Admission Usual, Reasonable and Customary charges
Emergency Room Illness without In-patient Admission Additional $250 deductible
Dental Injury Due to Accident - $500
Sudden and Unexpected Pain - $350
INTERNATIONAL EMERGENCY CARE
Emergency Medical Evacuation $50,000 Lifetime Maximum
Emergency Reunion $15,000
Return of Mortal Remains $25,000
Political Evacuation Up to $10,000
ADDITIONAL BENEFITS
Accidental Death $25,000
Dismemberment $25,000 - Two limbs
$12,500 - One limb
Terrorism Coverage Up to $50,000 Lifetime Maximum
Pre-existing Conditions $500 per year; $50,000 lifetime maximum - after 12 months of continuous coverage
Incidental Home Country Coverage Up to a cumulative two weeks
OPTIONAL ADD-ON PLAN
Baggage Loss/theft of Baggage - $250
Loss/theft of Valuables - $250
Loss/theft of Personal Papers - $250
Legal Assistance Binder Fee - $500 when served with summons
Personal Liability

Injury to third party - $2,000 limit after $100 deductible

Damage to third person property - $500 limit after $100 deductible.
                                                              Secondary to any other insurance in force

Limited High School Sports Coverage Usual, Reasonable and Customary charges
OPTIONAL RIDER Applies to all individuals listed on the Application Form
Adventure Sports Rider
(available to insureds up to age 65 - apply 1.20 rate factor)
 Age                Lifetime Maximum
 0 - 49                    $50,000
 50 - 59                  $30,000
 60 - 64                  $15,000

DESCRIPTION OF BENEFITS

The following is a partial list of benefits and terms that are offered on the Patriot Exchange Program plans.

EMERGENCY ROOM:
 
Charges incurred for the use of the Emergency Room due to an accident are covered up to the per injury plan maximum. Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.
 
DENTAL:
 
Injury due to an accident - The Standard Short-Term Travel Plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident.
 
Sudden dental pain - The Standard Short-Term Travel Plan will pay for the necessary treatment of sudden, unexpected pain to sound natural teeth.
 
INTERNATIONAL EMERGENCY CARE
 
POLITICAL EVACUATION:
 
If the United States Department of State, Bureau of Consular Affairs, or similar government agency of the Insured Person’s Home Country, orders the evacuation of all non-emergency government personnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to a $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that:
  • The Insured Person contacts the Company within 10 days of the issuance of the evacuation order by the United States Department of State, Bureau of Consular Affairs, or similar government agency of the Insured Person’s Home Country; and
  • The evacuationorder pertains to persons from the same Home Country as the Insured Person; and
  • Political Evacuation and Repatriation is approved and coordinated by the Company. In no event will the Company pay for a Political Evacuation if there is a Travel Warning in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.

EMERGENCY EVACUATION:

Each plan includes coverage for emergency medical evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to the indicated amount per plan design.

EMERGENCY REUNION:
 
Each plan provides emergency reunion coverage for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
 
RETURN OF MORTAL REMAINS:
 
If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered.
 
To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.
 
INCIDENTAL HOME COUNTRY COVERAGE:
 
During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to:
  • The insured person must have left their home country,
  • The total Period of Coverage must be for a minimum of 30 days, and
  • The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.

ACCIDENTAL DEATH AND DISMEMBERMENT:

Each plan includes a principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage:

  • Accidental Loss of life - principal sum;
  • Accidental Loss of two Members - principal sum;
  • Accidental Loss of one Member - principal sum. “Member” means hand, foot or eye.

TERRORISM:

Each plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse for eligible medical claims. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person's date of arrival.
 
This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.
 
LOST LUGGAGE:
 
This benefit will be paid in the event that the Common Carrier permanently loses an insured person’s checked luggage. This coverage is secondary to any other available coverage, including the Carrier’s.
 
DESCRIPTION OF OPTIONAL RIDER
 
ADVENTURE SPORTS RIDER:
 
The Adventure Sports Rider for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page four: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. These adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.